<?php echo $header; ?>
<?php if ($error_warning) { ?>
<div class="warning"><?php echo $error_warning; ?></div>
<?php } ?>
<div id="page">
        <?php echo $column_left; ?>
        <div id="content">
            <?php echo $content_top; ?>
          <div class="breadcrumb">
            <?php foreach ($breadcrumbs as $breadcrumb) { ?>
            <?php echo $breadcrumb['separator']; ?><a href="<?php echo $breadcrumb['href']; ?>"><?php echo $breadcrumb['text']; ?></a>
            <?php } ?>
          </div>
          <h1><?php echo $heading_title; ?></h1>
          <?php echo $text_description; ?>
          <form action="<?php echo $action; ?>" method="post" enctype="multipart/form-data">
            <h2><?php echo $text_order; ?></h2>
            <div class="content">
              <div class="left"><span class="required">*</span> <?php echo $entry_firstname; ?><br />
                <input type="text" name="firstname" value="<?php echo $firstname; ?>" class="large-field" />
                <br />
                <?php if ($error_firstname) { ?>
                <span class="error"><?php echo $error_firstname; ?></span>
                <?php } ?>
                <br />
                <span class="required">*</span> <?php echo $entry_lastname; ?><br />
                <input type="text" name="lastname" value="<?php echo $lastname; ?>" class="large-field" />
                <br />
                <?php if ($error_lastname) { ?>
                <span class="error"><?php echo $error_lastname; ?></span>
                <?php } ?>
                <br />
                <span class="required">*</span> <?php echo $entry_email; ?><br />
                <input type="text" name="email" value="<?php echo $email; ?>" class="large-field" />
                <br />
                <?php if ($error_email) { ?>
                <span class="error"><?php echo $error_email; ?></span>
                <?php } ?>
                <br />
                <span class="required">*</span> <?php echo $entry_telephone; ?><br />
                <input type="text" name="telephone" value="<?php echo $telephone; ?>" class="large-field" />
                <br />
                <?php if ($error_telephone) { ?>
                <span class="error"><?php echo $error_telephone; ?></span>
                <?php } ?>
                <br />
              </div>
              <div class="right"><span class="required">*</span> <?php echo $entry_order_id; ?><br />
                <input type="text" name="order_id" value="<?php echo $order_id; ?>" class="large-field" />
                <br />
                <?php if ($error_order_id) { ?>
                <span class="error"><?php echo $error_order_id; ?></span>
                <?php } ?>
                <br />
                <?php echo $entry_date_ordered; ?><br />
                <input type="text" name="date_ordered" value="<?php echo $date_ordered; ?>" class="large-field date" />
                <br />
              </div>
            </div>
            <h2><?php echo $text_product; ?></h2>
            <div id="return-product">
              <div class="content">
                <div class="return-product">
                  <div class="return-name"><span class="required">*</span> <b><?php echo $entry_product; ?></b><br />
                    <input type="text" name="product" value="<?php echo $product; ?>" />
                    <br />
                    <?php if ($error_product) { ?>
                    <span class="error"><?php echo $error_product; ?></span>
                    <?php } ?>
                  </div>
                  <div class="return-model"><span class="required">*</span> <b><?php echo $entry_model; ?></b><br />
                    <input type="text" name="model" value="<?php echo $model; ?>" />
                    <br />
                    <?php if ($error_model) { ?>
                    <span class="error"><?php echo $error_model; ?></span>
                    <?php } ?>
                  </div>
                  <div class="return-quantity"><b><?php echo $entry_quantity; ?></b><br />
                    <input type="text" name="quantity" value="<?php echo $quantity; ?>" />
                  </div>
                </div>
                <div class="return-detail">
                  <div class="return-reason"><span class="required">*</span> <b><?php echo $entry_reason; ?></b><br />
                    <table>
                      <?php foreach ($return_reasons as $return_reason) { ?>
                      <?php if ($return_reason['return_reason_id'] == $return_reason_id) { ?>
                      <tr>
                        <td width="1"><input type="radio" name="return_reason_id" value="<?php echo $return_reason['return_reason_id']; ?>" id="return-reason-id<?php echo $return_reason['return_reason_id']; ?>" checked="checked" /></td>
                        <td><label for="return-reason-id<?php echo $return_reason['return_reason_id']; ?>"><?php echo $return_reason['name']; ?></label></td>
                      </tr>
                      <?php } else { ?>
                      <tr>
                        <td width="1"><input type="radio" name="return_reason_id" value="<?php echo $return_reason['return_reason_id']; ?>" id="return-reason-id<?php echo $return_reason['return_reason_id']; ?>" /></td>
                        <td><label for="return-reason-id<?php echo $return_reason['return_reason_id']; ?>"><?php echo $return_reason['name']; ?></label></td>
                      </tr>
                      <?php  } ?>
                      <?php  } ?>
                    </table>
                    <?php if ($error_reason) { ?>
                    <span class="error"><?php echo $error_reason; ?></span>
                    <?php } ?>
                  </div>
                  <div class="return-opened"><b><?php echo $entry_opened; ?></b><br />
                    <?php if ($opened) { ?>
                    <input type="radio" name="opened" value="1" id="opened" checked="checked" />
                    <?php } else { ?>
                    <input type="radio" name="opened" value="1" id="opened" />
                    <?php } ?>
                    <label for="opened"><?php echo $text_yes; ?></label>
                    <?php if (!$opened) { ?>
                    <input type="radio" name="opened" value="0" id="unopened" checked="checked" />
                    <?php } else { ?>
                    <input type="radio" name="opened" value="0" id="unopened" />
                    <?php } ?>
                    <label for="unopened"><?php echo $text_no; ?></label>
                    <br />
                    <br />
                    <?php echo $entry_fault_detail; ?><br />
                    <textarea name="comment" cols="150" rows="6"><?php echo $comment; ?></textarea>
                  </div>
                  <div class="return-captcha"><b><?php echo $entry_captcha; ?></b><br />
                    <input type="text" name="captcha" value="<?php echo $captcha; ?>" />
                    <br />
                    <img src="index.php?route=account/return/captcha" alt="" />
                    <?php if ($error_captcha) { ?>
                    <span class="error"><?php echo $error_captcha; ?></span>
                    <?php } ?>
                  </div>
                </div>
              </div>
            </div>
            <div class="buttons">
              <div class="left"><a href="<?php echo $back; ?>" class="button"><?php echo $button_back; ?></a></div>
              <div class="right">
                <input type="submit" value="<?php echo $button_continue; ?>" class="button" />
              </div>
            </div>
          </form>
          <?php echo $content_bottom; ?>
        </div>
        <?php echo $column_right; ?>
</div>
<script type="text/javascript"><!--
$(document).ready(function() {
	$('.date').datepicker({dateFormat: 'yy-mm-dd'});
});
//--></script> 
<?php echo $footer; ?>